Robotic magnetic navigation for atrial fibrillation ablation
Robotic magnetic navigation for atrial fibrillation ablation
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DOI：
10.1016/j.jacc.2005.11.058
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发表时间：
2006-04-04
影响因子：
24
通讯作者：
Santinelli, V
中科院分区：
文献类型：
--
作者：
Pappone, C;Vicedomini, G;Santinelli, V
目的：评估磁导管引导心房颤动（AF）患者行环肺静脉消融（CPVA）的可行性。背景：目前还没有关于AF消融远程导航可行性的数据。方法40例有症状的房颤患者使用NIOBE II远程磁系统（Stereotaxis Inc., St. Louis, Missouri）接受CPVA治疗。消融采用4毫米尖端，磁导管（65℃，最大50 W， 15 s）。导管尖端由均匀磁场（0.08 t）和电机驱动（Cardiodrive unit, Stereotaxis Inc.）引导。左心房地图使用集成的CARTO RMT系统（Stereotaxis Inc.）创建。消融终点为电压降低至双极电晶幅值的90%左右。结果40例患者中38例远程消融成功，无并发症。中位定位和消融时间为152.5分钟（范围90 - 380分钟），但前12例患者的时间更长（192.5分钟vs 148分钟；p = 0.012）。中位消融时间为49.5 min（范围17 ~ 154 min），但后28例患者的消融时间明显短于前12例患者（49 min vs. 70 min; p = 0.021）。行远程消融的患者手术时间较对照组长（p < 0.001），其右侧肺静脉定位时间相似，但消融时间较短。远程收集了更多的地图点，而不考虑它们的位置（p < 0.001）。结论远程磁导航用于房颤消融安全可行，学习曲线短。尽管所有手术都是由经验丰富的操作人员进行的，但即使是经验不足的操作人员也可以进行远程心房颤动消融。
OBJECTIVES We assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation (AF) undergoing circumferential pulmonary vein ablation (CPVA).BACKGROUND No data are available on feasibility of remote navigation for AF ablation.METHODS Forty patients under-went CPVA for symptomatic AF using the NIOBE II remote magnetic system (Stereotaxis Inc., St. Louis, Missouri). Ablation was performed with a 4-mm tip, magnetic catheter (65 degrees C, maximum 50 W, 15 s). The catheter tip was guided by a uniform magnetic field (0.08-T), and a motor drive (Cardiodrive unit, Stereotaxis Inc.). Left atrium maps were created using an integrated CARTO RMT system (Stereotaxis Inc.). End point of ablation was voltage abatement > 90% of bipolar electrograin amplitude.RESULTS Remote ablation was successful in 38 of 40 patients without complications. The median mapping and ablation time was 152.5 min (range, 90 to 380 min) but was much longer in the first 12 patients (192.5 min vs. 148 min; p = 0.012). Median ablation time was 49.5 min (range, 17 to 154 min), but it was much shorter in the last 28 patients than in the first 12 patients (49 min vs. 70 min; p = 0.021). Patients receiving remote ablation had longer procedure times than control patients (p < 0.001) with similar mapping time but shorter ablation time on right-sided pulmonary veins. Many more mapping points regardless of their location were collected remotely (p < 0.001).CONCLUSIONS Remote magnetic navigation for AF ablation is safe and feasible with a short learning curve. Although all procedures were performed by a highly experienced operator, remote AF ablation can be performed even by less experienced operators.